Date: 06 May 1998 18:29:31
From: aidsnews@igc.org
Subject: AIDS Treatment News #294
AIDS Treatment News Issue #294, May 1, 1998
phone 800-TREAT-1-2, or 415-255-0588
CONTENTS:
VIAGRA Warning re "Poppers" and Notice re Protease Inhibitors
Preventing Mother-Infant Transmission Worldwide: What Is
Needed? Interview with Joseph Saba, M.D.
HIV Treatment Options
Community Organizing by Email: Needle Exchange Mobilization
Example
15th Annual Candlelight March, May 17
San Francisco: Healing Alternatives Opens Castro Office
***** VIAGRA Warning re "Poppers" and Notice re Protease
Inhibitors
by John S. James
Using "poppers"--nitrate inhalants--at the same time as the
new impotence drug VIAGRA(TM) (sildenafil) can cause
dangerous hypotension--abnormally low blood pressure--because
of the way the two drugs interact. VIAGRA developer Pfizer
Inc. did not run interaction tests with the street drugs, but
it did test combining VIAGRA with nitrates used for treating
angina (a heart condition), which work similarly. Due to the
results of these tests, the package insert contains the
following warning: "VIAGRA was shown to potentiate the
hypotensive effects of nitrates and its administration in
patients who use nitric oxide donors or nitrates in any form
is therefore contraindicated."
Effect of Protease Inhibitors and Other P450 3A4 Inhibitors
VIAGRA does not affect the blood levels of protease
inhibitors, or other drugs used in HIV treatment, as far as
is known. However, protease inhibitors (especially ritonavir)
and certain other drugs (for example, ketoconazole,
itraconazole, or erythromycin) increase the blood levels of
VIAGRA by inhibiting the enzyme p450 3A4, which the body uses
to eliminate VIAGRA. Pfizer does not expect this effect to
cause serious risks, but does suggest that patients using
such drugs consider trying a lower dose of VIAGRA first.
(Pfizer has not tested its drug with ritonavir or other HIV
protease inhibitors, however.)
VIAGRA is usually taken as a 50 mg dose, from half an hour to
four hours before sexual activity (preferably one hour
before). This dose can be decreased to 25 mg., or increased
to 100 mg., depending on efficacy or side effects. Overdoses
up to 800 mg have been tested, and have caused increased side
effects including headache, facial flushing, and visual
abnormalities, but did not present serious safety concerns;
these higher doses had no significant increase in efficacy.
For patients using p450 3A4 inhibitors, or who have other
conditions which can interfere with the elimination of
VIAGRA, the package insert suggests trying a lower dose:
"Since higher plasma levels may increase both the efficacy
and incidence of adverse events, a starting dose of 25 mg
should be considered in these patients."
***** Preventing Mother-Infant Transmission Worldwide: What
Is Needed? Interview with Joseph Saba, M.D.
by John S. James
Every year over 500,000 infants are infected with HIV from
their mother, before or during birth or shortly after, and
almost 500,000 children die. More than half of these
infections and deaths could be prevented by treating pregnant
women before birth. A recent clinical trial in Thailand
showed that a less-intensive AZT regimen, suitable for
developing countries, was effective. Two weeks later, Glaxo-
Wellcome offered to reduce the price of the drug for treating
pregnant women by up to 75%--an important step forward, as it
brings the drug cost of the full regimen to as low as $50.
But aside from cost of the drug, there are major logistical
problems to making this treatment available. We asked Joseph
Saba, M.D., Clinical Research Specialist with UNAIDS (the
Joint United Nations Programme on HIV/AIDS), to explain what
is needed now.
AIDS TREATMENT NEWS: Give our readers a short history on
antiretroviral drug treatment to prevent mother-to-infant HIV
transmission.
Dr. Saba: Everything started in 1994 when the first results
of the study ACTG 076--a clinical trial in pregnant women in
the U.S. and Europe--showed that AZT started between week 14
and 34 of pregnancy and continued until delivery, and given
after birth for six weeks to the baby, could very
significantly reduce the risk of mother-child transmission.
Following these results, the World Health Organization held a
meeting in Geneva to see how they could be applicable to the
developing countries.
It became clear that these results were not applicable in
many countries, because the AZT regimen was long, and started
before most women come to prenatal clinic in many developing
countries; also, this regimen required intravenous treatment.
It was logistically and financially impossible to implement
in many developing countries.
So new trials were designed to test regimens that could be
more widely used. One of these trials, sponsored by the U.S.
Centers for Disease Control and conducted in Thailand, was
completed in December 1997; the analysis was then done and
results were announced in February of this year. This trial
showed that transmission could be greatly reduced with a
regimen which starts at week 36 of pregnancy, is given to
women twice daily instead of five times daily the way the
ACTG 076 regimen was, did not require intravenous treatment
during delivery, and did not require treatment of the baby.
So it is shorter and much easier to apply, and could work in
developing countries. Other trials are now testing different
regimens--without the placebo arms, which were stopped after
the Thailand results became available. While these trials are
ongoing we have been working on how to make any intervention
that is applicable in developing countries really within the
reach of these countries.
Several issues had to be addressed. How could the prenatal
care system be adapted? What are the requirements in terms of
voluntary counseling and testing? Will the women accept the
intervention? And is it cost-effective, compared with other
public- health programs?
We found that the treatment was acceptable; the women really
wanted to use antiretrovirals to save their children from
getting infected. Accepting the testing is a different issue,
because it can result in discrimination, and then the women
are afraid from their husband, or their family, or at their
work. But once the testing has been done, they usually agree
to take the medication.
When the Thai study results were announced, we adopted our
cost-effectiveness model and found that this treatment was
clearly cost effective--saving as many lives and sometimes
more than the same investment in blood screening for HIV. It
compares well to other public-health interventions.
Also while the trials were ongoing, we were in discussions
with Glaxo-Wellcome. They were involved in these studies, and
we continued discussion on how we could make the regime
affordable to developing countries. You probably know about
the Glaxo Wellcome announcement [on price reductions for
AZT].
So as soon as we got the results, we were able to figure out
how practical this intervention could be, and how applicable
it is in developing countries.
ATN: What is needed now?
Dr. Saba: Last month in Geneva, a meeting hosted by UNAIDS in
collaboration with WHO and UNICEF looked at the practical
aspects, and the next steps now. This group decided to set up
a mechanism to accelerate technical development and discuss
the logistics with the countries interested in doing
programs, to make this happen as quickly as possible.
ATN: To give people a sense of the overall size of the effort
required, about how many women each year become pregnant who
are HIV positive?
Dr. Saba: According to UNAIDS estimates, more than half a
million babies each year are born with HIV infection, or
acquire it early after birth, from mother-to-child
transmission. So working from the HIV transmission rate, we
estimate that between two and three million pregnant women
are HIV-infected.
ATN: How many women will have to be tested to find them?
Dr. Saba: That depends on the HIV prevalence. In countries
like Zimbabwe, where 35% of pregnant women are infected, you
would have to test three times more. In countries where
fifteen percent of the women are infected, seven times more
women must be tested. In countries like Thailand, where the
prevalence is 2.4%, you could compute similarly.
We modeled the cost effectiveness, and if the prevalence rate
is very low, then maybe one should not use a program of mass
testing and counseling, but either target settings where
prevalence is higher, or focus testing on those women known
to be exposed to HIV in one way or another. When the
prevalence rate is over 5%, it may be more cost-effective to
offer testing to everybody. We will need to test many more
women than are HIV-positive--maybe 20 or 30 million--to
provide this treatment worldwide.
There are major problems in reaching many of these women. In
some countries, fewer than 60% of pregnant women attend
prenatal clinics. Many come at least once for prenatal care,
but they do not necessarily deliver; in some areas of
Tanzania or Uganda, for example, as few as 30% of women who
have come for prenatal care deliver at the hospital. The
reason is usually just the lack of transport, the lack of a
telephone, to get there. But many come to a clinic during
pregnancy, so at this time we could consider giving them the
antiretroviral treatment.
Making such a program available to all pregnant women who
really need it will take a long time. First you need to reach
the women who attend prenatal clinic--then the women who do
not attend, which is difficult.
We need to look at this like the vaccine programs. This
treatment is like a vaccine for the child, for preventing HIV
infection in the child. When the expanded programs on
immunization were established, it took years to be able to
reach the whole population in a country.
ATN: Therefore this will be a long-term effort, working with
the countries, and different in each country?
Dr. Saba. Yes, exactly. It is a long-term effort which needs
to start now. We also must strengthen prenatal care; you need
to have trained doctors and nurses, and have adequate care
given to pregnant women, if we are to give them
antiretrovirals.
And one must not forget about transmission through breast
feeding, and the need to provide these women alternatives;
this also requires logistics.
ATN: How can we approach the problem of violence and
discrimination against women who test positive?
Dr. Saba: That is a very serious problem. There are basic
principles. One must respect the choice of women to be tested
and counseled. Also, this must be done in a very confidential
way, with appropriate counseling. Confidentiality is
essential because it will increase the credibility of the
center in the testing process, and also it will help protect
the women against any possible discrimination.
ATN: Are there programs in operation today where AZT is being
delivered at a reduced price?
Dr. Saba: Not yet, but many countries are already designing
programs, and some have contacted Glaxo Wellcome. We hope
that within the next few months we will have programs ready
to go in these countries. Thailand, for example, is very
interested in implementing the process as quickly as
possible; so is Zimbabwe.
ATN: What can our readers do, what can AIDS organizations
within the United States do to help in this process?
Dr. Saba: It will be a lot of work for everybody--in
designing programs, in helping the countries, helping the
communities in these countries to take part in the process,
and developing the advocacy messages that still need to go
out. Now there is an increased momentum for this issue--for
the access to drugs in general, and also for mother-to-child
transmission. We need to keep this momentum growing, to turn
the research findings into reality in developing countries.
A few years ago, when HIV blood screening was advocated,
there were difficulties and restrictions and financial
problems. Now the blood supply is screened in most countries.
We need to keep driving this momentum. It is an effort for
all of us.
***** HIV Treatment Options by Denny Smith
This is AIDS TREATMENT NEWS' third annual overview of
antiretroviral drugs.
The best use of these drugs is still evolving, but several
ideas have become the foundation for the current standard of
care:
1. The goal of effective treatment is to slow viral
replication to undetectable limits. Today that usually
requires at least three drugs.
2. Resistance to these drugs can develop quickly if too many
doses are missed. So if a drug is too difficult to tolerate
or too complicated to manage, it should be replaced with
another choice.
3. Viral loads that rise appreciably above detectable limits
suggest that resistance to one or more of the drugs has
developed, and a change of treatment should be considered. As
with CD4 counts, one lab result is not a dependable trigger
for a major decision; at least one more viral load should be
drawn. But once a decision is made to change a regimen, all
three drugs should be replaced at the same time, since
switching or adding just one or two makes it easy for the
virus to become resistant again.
Common adult doses are given for the drugs listed below;
pediatric dosing and formulations can be found in the
Physician's Desk Reference. Also, the side effects described
are only the most common or important ones, and everyone
should be prepared for less expected effects. If you are
having a problem with your medications, or stop taking them
for any reason, call your health-care provider immediately.
Nucleoside Analog Reverse Transcriptase Inhibitors
These drugs work by inhibiting an enzyme--reverse
transcriptase--which the virus needs to take over a cell's
machinery.
AZT, also called zidovudine, is marketed under the brand name
Retrovir(R). AZT can be combined with most other
antiretrovirals, but probably should not be used with d4T. It
can cause headaches and stomach upset, but these usually go
away after a couple weeks. Over extended periods of use, it
can cause anemia (low production of red blood cells),
neutropenia (low white cells) and myopathy (damage to muscle
fibers). These problems resolve if the drug is discontinued.
The usual prescription for AZT is two capsules (200 mg) taken
three times a day, or one 300 mg capsule taken twice a day.
AZT is also marketed in a tablet called Combivir, which also
contains 3TC (300 mg of AZT and 150 mg of 3TC). There is a
liquid suspension as well, which is easier to manage for
children and people who have difficulty swallowing.
ddI, or didanosine, is sold under the brand name VIDEX(R) and
can be combined with most other antiretrovirals. It can cause
pancreatitis and peripheral neuropathy, so if you experience
abdominal pain, or tingling and numbness in your toes or
fingers, call your provider. The usual prescription for ddI
is two tablets (125 or 200 mg, depending on body weight)
taken twice a day on an empty stomach with water. Many people
do not like the chalky texture of the original ddI
formulation; the orange-flavored version may be a bit easier
to take. It also comes in a powder that can be mixed in
water. Some providers feel that ddI is just as effective and
more convenient if the entire daily amount is taken in one
dose. But in that case, the strength and number of tablets
must be calibrated to obtain the correct level of buffering
agent in the tablets. A pharmacist can figure that out.
ddC, or zalcitabine, is sold as HIVID(R), and can be combined
with most other antiretrovirals. Like ddI, ddC can cause
pancreatitis and peripheral neuropathy; if you experience
abdominal pain or tingling and numbness in your toes or
fingers, call your provider. The usual prescription for ddC
is one tablet (0.75 mg) taken three times a day.
d4T, or stavudine, is marketed as Zerit(R). It can be
combined with most other antiretrovirals, but probably should
not be used with AZT. Like the other "d" drugs, d4T can cause
pancreatitis and peripheral neuropathy, so if you experience
abdominal pain, or tingling and numbness in your toes or
fingers, call your provider. The usual prescription for d4T
is one capsule (30 or 40 mg, depending on body weight) taken
twice a day. It also comes in a liquid suspension.
3TC, or lamivudine, is marketed as Epivir(R), and can be
combined with any other antiretroviral. It can cause
headaches and insomnia in some people, but these usually go
away after a few weeks. The usual prescription for 3TC is one
tablet (150 mg) taken twice a day. It also comes in a tablet
called Combivir that has AZT added (300 mg of AZT and 150 mg
of 3TC). And it comes in a liquid suspension as well.
Abacavir, also known as 1592 or Ziagen(TM), is dispensed
through an "expanded-access" program, which means it is still
experimental but is available for persons who have failed
other therapies. Abacavir is an important drug, but users
need to know about a potentially serious hypersensitivity
reaction that happens in about 3% of patients; this usually
begins from a few days to four weeks after starting the drug,
and it will go away without further problem if the drug is
stopped and not restarted. If you develop fever, nausea, and
malaise (and sometimes a rash) while taking this drug--signs
of this reaction--call your provider immediately. If you stop
taking abacavir because of hypersensitivity, NEVER RESTART
IT, since restarting after hypersensitivity can cause a more
serious and possibly fatal reaction. Dosing for abacavir is
300 mg taken twice a day.
Non-Nucleoside Reverse Transcriptase Inhibitors
Nevirapine is sold under the brand name Viramune(R), and has
been combined with all other antiretrovirals. Nevirapine can
cause a serious rash, but this can usually be avoided by
starting with a low dose, one tablet taken once a day for two
weeks, and then doubled to the usual prescription: one tablet
(200 mg) twice a day. Nevirapine may lower the blood levels
of other drugs; when combined with indinavir in particular,
the indinavir is usually increased from 800 mg to 1000 mg
each dose.
Delavirdine is approved as Rescriptor(R), and has been used
with all other antiretrovirals. Like nevirapine, it can cause
a rash in some people. The usual prescription for delavirdine
is four pills (400 mg) taken three times a day.
Efavirenz, also known as DMP-266 or SUSTIVA(TM), is available
under an expanded-access program to people with CD4 counts of
400 or less and a history of failing the approved
antiretrovirals. This drug can cause light-headedness when
taken with AZT, 3TC or indinavir; it can also cause kidney
irritation, so that drinking plenty of water is important.
The usual dosing for efavirenz is three pills (600 mg) taken
once a day, although the expanded-access protocol allows for
one pill taken three times a day. Efavirenz, like nevirapine,
may lower the levels of other drugs. If combined with
indinavir, each indinavir dose should be increased from 800
mg to 1000 mg. Efavirenz should NOT be taken during
pregnancy, since it was reported to cause birth defects in
recent monkey studies.
Nucleotide Reverse Transcriptase Inhibitors
Adefovir, also known as bis-POM PMEA or PREVEON(TM), is
available through an expanded-access program for people who
have failed at least two nucleoside analogs and one protease
inhibitor. Adefovir can cause nausea and vomiting, and may
lower levels of carnitine in the body. Dosing for adefovir is
one pill (120 mg) taken once a day with 500 mg of carnitine.
Protease Inhibitors
These drugs target a different enzyme of the virus--protease-
-which is essential for HIV to assemble working copies of
itself.
Saquinavir is sold under the brand name FORTOVASE(R). (An
older version, called Invirase, was not absorbed very well;
note the new dosing for FORTOVASE.) Saquinavir can be
combined with all other antiretrovirals, and may work
especially well with ritonavir, using lower doses of both
drugs. Saquinavir can cause stomach upset and elevated liver
enzymes, and should be used with caution with certain other
medications. The usual prescription for saquinavir--unless
combined with ritonavir--is six capsules (1200 mg) taken
three times a day with food. The usual dose when combined
with ritonavir is 400 mg of each drug, taken twice a day.
Ritonavir is marketed as Norvir(R). Ritonavir can be combined
with most other antiretrovirals, and may work especially well
in combination with saquinavir, using a low dose. However,
there are many drugs, both prescribed and recreational, that
should be taken with caution or not at all with ritonavir.
Make your provider aware of all drugs you might take.
Ritonavir can cause stomach upset, generalized discomfort and
tingling or numbness around the mouth. These might be avoided
by starting with a low dose, three capsules taken twice a day
with food, and adding one capsule each dose every couple days
until the usual prescription is tolerated: six capsules (600
mg) taken twice a day. That dose will be lower, 400 mg, if
combined with saquinavir. The capsules should be stored in a
refrigerator. There is also a liquid formulation of
ritonavir.
Indinavir is sold under the brand name Crixivan(R), and can
be used with most other antiretrovirals. Indinavir can cause
stomach upset, kidney stones and generalized discomfort,
although drinking plenty of fluids may prevent the kidney
stones. It should be used with caution with certain other
medications, so make sure your provider knows about
everything you are taking. The usual prescription for
indinavir is two capsules (800 mg) taken three times a day on
an empty stomach with a large glass of water. That dose may
be larger, 1000 mg, if indinavir is combined with nevirapine
or efavirenz.
Nelfinavir is approved under the trade name Viracept(R), and
has been combined with all other antiretrovirals. It can
cause stomach upset and diarrhea, and should be used with
caution with certain other medications. The usual
prescription for nelfinavir is three tablets (750 mg) taken
three times a day with food. But it may also be effective
when taken twice a day, five tablets (1250 mg) each dose.
There is a powdered formulation of nelfinavir that can be
mixed in water.
Ribonucleotide Reductase Inhibitors
This class targets an enzyme which the virus needs and which
is made by blood cells. So far, the only available drug which
works this way is hydroxyurea, which was approved years ago
to treat certain cancers. But at least one more drug like
this is under development.
Hydroxyurea, also called Hydrea, may work especially well
with ddI. It can lower white and red cell counts, although
that is unlikely at the low doses used for HIV infection: 500
to 1000 mg daily. (It may be more likely, however, when
combined with drugs that pose the same problem, such as AZT
or ganciclovir.) The effect of hydroxyurea on HIV replication
is somewhat indirect, so it should probably be considered
only an addition to a standard, three-drug regimen.
***** Community Organizing by Email: Needle Exchange
Mobilization Example
by John S. James
Last week's events around needle exchange provide an example
of how email can be used for political mobilization--and
suggest ways to use this medium effectively.
On April 21--the day after the U.S. Department of Health and
Human Services announced its finding that needle exchange was
effective in preventing HIV transmission without increasing
drug use, but that Federal funding of these programs would
still be banned--USA TODAY conducted a reader poll on the
funding issue, through its Web site (www.usatoday.com). Such
polls are clearly unreliable for estimating public opinion
(even when, like this one, they have software to prevent
people from voting repeatedly). But they do show the
effectiveness of each side in getting its supporters
mobilized, which can be at least as important.
Early in the morning only 25% of 4500 votes supported needle
exchange, with almost all of the rest opposed. Throughout the
day a flurry of emails went out--we received 20 (not counting
duplicates), even though we are not on needle-exchange lists-
-and by late evening the vote had completely turned around
and was more than 68% in favor.
Apparently no one involved had any advance notice, and yet
this entire mobilization took place within a single day. The
first email, as far as we can determine, was sent in the
morning by Project Inform's Treatment Action Network (TAN),
which heard about the poll from a member who saw it in the
newspaper or on the Web; this alert went to about 350 members
who tend to be very active, and who forwarded it to others.
At about the same time the AIDS Action Council sent its alert
on the poll to a fax list of several thousand AIDS
organizations. Fax alerts may not work as well as email,
because it is much harder for recipients to forward them to
their own lists; but in this case the document was short,
because those involved already knew the issues, so action
alerts could easily be typed from the fax into email, with no
need to re-enter long background papers.
An analysis of the changing vote during the day suggests that
after the emails were out, the Yes votes outnumbered the No
by about seven to one--compared to three to one the opposite
way before the email mobilization.
Here are some conclusions we drew:
* What makes email work is *people*, not software or massive
mailing lists. Almost all of the email we received was from
persons or organizations we knew, which made it compelling.
Just automating the process and sending to strangers produces
spam, not effective mobilization.
* Several individuals who emailed us also sent their entire
list of recipients. That is often a bad idea, because people
can get unwanted email if the list goes astray. But in this
case it showed us that many of the individuals had personal
activist lists consisting of several dozen (mostly people,
but also including organizations, and addresses of
specialized email lists which would further distribute the
messages to persons unlikely to have received it already).
And the fact that these senders still included their personal
activist email list with their message suggests that those
involved know and trust each other.
* The structure of this one-day, decentralized, effective
mobilization was as follows:
- The issue was particularly important to many people.
- It was well known to them, so it needed no lengthy
background paper (which would stop many busy recipients).
- There was an easy way to act--without needing to compose a
letter, without spending money, and without any illusion that
one must be some kind of expert in the subject in order to
respond.
- The first organizations and individuals to get the word out
were able to move rapidly without advance notice.
- Then other organizations and individuals (often with
personal lists of dozens) carried out the main part of the
mobilization, usually quoting the earlier emails but also
including their own messages urging their friends and
colleagues to vote. Established email distribution lists like
AIDSACT allowed further conversation, including those who did
not have large activist lists of their own. [For more
information on AIDSACT, send email to listproc@critpath.org,
with "info aidsact"--without the quotes--in the first line.]
- All these communications were between people who know and
respect each other, who already had working relationships.
- The result is that thousands of interested individuals each
received many communications from friends and colleagues
urging them to vote that day in the poll. And thousands did
vote.
[Any email action alert should have an expiration date, so
that copies will not keep being redistributed indefinitely,
long after they are useful; here the USA TODAY poll was only
for one day, so the expiration was implicit. Also, requests
for a Web or email response should include the entire
computer address--which will provide a "hot link" in most
email software, allowing users to vote or otherwise respond
without leaving their email session.]
The bottom line is that to respond so effectively on such
short notice, the community needed two things. First, one or
more major organizations (or possibly unaffiliated
individuals) must be paying attention, be able to move
quickly, and have large lists of constituents so that they
can reach many interested people immediately. Second--and at
least equally important--there must be many individuals and
organizations who can personalize the message and pass it on
to their friends and colleagues.
This whole mobilization had essentially zero financial cost.
Therefore there were no delays to approve spending, and when
an organization could not make a decision immediately, people
could act on their own. Without spending any money, thousands
of people across the country were mobilized to act together--
in less than a day.
Here is a way for communities to defend themselves in a world
of big money, power, and institutions which are often deaf or
corrupt, and repeatedly run amuck. Committed individuals are
central, not machinery. No matter where they live,
individuals and small groups can make a difference through
building their own constituencies on issues that matter to
them.
***** 15th Annual Candlelight March, May 17
The 15th International AIDS Candlelight Memorial and
Mobilization will take place in hundreds of cities throughout
the world on Sunday May 17. For more information, see
http://www.hooked.net/~candle, or contact Mobilization
Against AIDS, 415-863-4676, fax 415-863-4740, email
candle@hooked.net.
In San Francisco, a march will begin at 8:00 p.m. May 17, at
Castro and Market Streets.
***** San Francisco: Healing Alternatives Opens Castro Office
by John S. James
Healing Alternatives Foundation, one of the nation's original
AIDS buyers' clubs, opened a new retail location at the
corner of 18th and Castro Street. The organization also
maintains one of the largest AIDS libraries open to the
public, and will gradually move the library materials to the
new location as well.
HAF plans to continue some retail sales at the old space
until members learn about the move, then use that space for
community events and programs. Some of the older library
publications may stay there as well. (The phone number at the
old space, 1748 Market St., is 415-626-2316.)
The public is invited to a grand opening celebration set for
Saturday, May 30, 2-5 p.m., at the new location, 505 Castro
Street (in the Bank of America building), on the second floor
(wheelchair accessible by elevator). However, this office is
already open for business, 10 a.m. - 7 p.m. Monday through
Saturday; anyone interested is invited to drop in.
Healing Alternatives has a vitamin/supplement program
available to anyone with financial difficulties, and it
recycles medicines to almost every continent. It can serve as
a safety net for persons on vacation or out of money.
Membership is open to all; you do not have to be HIV-
positive. For more information, call Healing Alternatives at
the Castro Street location, 415-626-4053, fax 626-0451, email
info@healingalternatives.org.
Comment
AIDS buyers' clubs have been changing for the last several
years. Their business volume has been squeezed between low-
cost health food products by mail order, on one hand, and
better official systems for access to new medicinal drugs on
the other. But the clubs have value to the community which is
more than economic:
* Occasionally they provide lifesaving access for persons who
otherwise would fall through the cracks (as recently with the
drug NTZ).
* Buyers' clubs offer services (like the library in San
Francisco) and companionship which health-food stores or
catalogs usually do not.
* It is important for many reasons that these non-profit
organizations, controlled by the community they serve, have a
working knowledge of this business, including how to obtain
potential treatments internationally.
* Buyers' clubs offer unique opportunities to work together
with other community projects--opportunities enhanced by the
new HAF site in a convenient and visible location.
Because of the new business environment, and the growing
shortfall of donations to AIDS groups, HAF recently
reorganized its operations to be more efficient. For
background, see "Major Changes Underway at Healing
Alternatives Foundation," by Bruce Mirken, SAN FRANCISCO BAY
TIMES April 16, 1998.
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ISSN # 1052-4207
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